Cannabis Dosing: Delivery Methods & Dosing Guidelines

[AKgramma]

I just found a good way to use my brewed canna-tinctures. I put two healthy droppersful in a glass of my favorite wine (Pinot Noir). No taste, no burn!

 

[SweetSue]

Please help spread the word.

Opioid Tapering With Cannabis - A Regimen

Thank you.

 

[SweetSue]

Some additional guidelines:

Current studies indicate that sublingual is no more effective than edible administration. In truth, most people using sublingual are swallowing the entire time, so to be honest, sublingual is really oral administration.

If it's really oral, why bother trying to keep it in the mouth all that time? Try smaller doses, spaced out through the day.

Mara Gordon's crew at Aunt Zelda's sees more efficient systemic use of cannbinoids therapies when you space the THC-dominant doses at least two hours from the CBD-dominant doses.

Their typical dosing schedule goes something like this:

* 10-15 mg of a THC med to start the day
* 2-4 hours later take half the daily dose of your CBD med
* 2-6 hours later take the rest of the CBD dose
* finish the day with the major THC dose before bed

This plan keeps the dominant cannabinoids from competing with each other and gets the majority of the euphoria out of the way during sleep hours.

 

[SweetSue]

I've been thinking about how to structure a general cannabinoid therapy, oral administration, and I think this is a good plan:

* Begin sub-therapeutically and in equal ratio THC:CBD - begin somewhere around 2.5 - 5 mg a day.
* Raise the dose by no more than 2.5 mg each until you feel any effect. Stay there until you adjust to feeling normal again.
* When you can, begin raising the dose again, until you feel the need to adjust to the euphoria again, or until you hit 10 mg of each major cannabinoid.
* Begin ramping up CBD to 2:1, to 3:1, and lastly to 5:1. You're hoping that one of these combinations are offering the relief you seek without more THC.
* If the 5:1 doesn't do it for you start ramping up both major cannabinoids by the same number of milligrams - if you increase THC by 5 mg you also increase CBD by the same amount.
* Many small doses throughout the day work more efficiently than one dose a day.

Without the addition of larger numbers of CBD you keep raising the THC dose and adjusting to the euphoria until you simply can't be comfortable, then you back off one step in the titration and euphoria backs off to a manageable level.

You won't see side effects with CBD doses until your into the hundreds of milligrams. If loose stools or diarrhea occur, look at those CBD levels and consider backing off a tad.


Obviously, this isn't the way to treat cancer. I'd go with suppositories as soon as the patient was introduced to the cannabinoids, say by the second week. You won't be able to function at the THC levels it takes to treat cancer if the administration is all through the gut.

But this plan may accomodate just about any disease state that you take oral canna meds for. At a 4:1 or 5:1 CBD:THC ratio you shouldn't feel the euphoric effects of THC at all. If you try this and you do get euphoric we'd appreciate hearing from you about it.

 

[Kriaze]

Hello SweetSue it's been awhile and it's good to see that your studies are still in full flow. I came here after reading about a cancer patient struggling with dosing and a link being posted to here and I ended up reading through everything as I tend to do as well as getting sidetracked from the original reason I came here, much to my delight of course.

While reading through a part of your notes I found something that was pertinent to my own reasons for using Cannabis (anxiety mainly) and I found myself getting confused, right at the point where you tell the reader not to. I'll post the actual quote(s) and hope that you can help me, I'm not sure if I'm tired and missing something but it would be great if you could clarify for me:


"Get this part right. Confusing this point will not not go well.
** Depression calls for a sativa-type stimulant.
** Anxiety calls for a relaxant, so choose an indica hybrid or a CBD-rich strain.

Both conditions will challenge you. Usually a choice of a hybrid or a mix of THC/CBD will do the trick.

* With anxiety avoid high doses of CBD, as this may cause anxiety"

This is the part that I'm finding confusing, the information seems contradictive in that for anxiety a CBD rich strain is recommended and then below as you can see it also states to avoid high CBD as this in itself may cause anxiety. I'm perplexed and wondering if you could point out what I'm missing please. You do actually reiterate that a high CBD strain is preferable lower down in your dosing summary which has me further wondering:

"* For anti-anxiety or anti-psychotic choose strains or meds high in CBD or an indica hybrid."

Thanks for any response in advance and I hope that you are well, once again thanks for providing me an interesting read, one of many I have enjoyed since joining the magazine. May your buds be forever bountiful

 

[AngryBird]

Hi Kriaze long time no see.
SweetSue's a bit buzy and she will be around shortly.

 

[Kriaze]

Hey Angry bird, good to see you again. Hope all is well and no rush here for any response, I'll be on and off over time anyway. All the best.

 

[SweetSue]

Hello SweetSue it's been awhile and it's good to see that your studies are still in full flow. I came here after reading about a cancer patient struggling with dosing and a link being posted to here and I ended up reading through everything as I tend to do as well as getting sidetracked from the original reason I came here, much to my delight of course.

While reading through a part of your notes I found something that was pertinent to my own reasons for using Cannabis (anxiety mainly) and I found myself getting confused, right at the point where you tell the reader not to. I'll post the actual quote(s) and hope that you can help me, I'm not sure if I'm tired and missing something but it would be great if you could clarify for me:


"Get this part right. Confusing this point will not not go well.
** Depression calls for a sativa-type stimulant.
** Anxiety calls for a relaxant, so choose an indica hybrid or a CBD-rich strain.

Both conditions will challenge you. Usually a choice of a hybrid or a mix of THC/CBD will do the trick.

* With anxiety avoid high doses of CBD, as this may cause anxiety"

This is the part that I'm finding confusing, the information seems contradictive in that for anxiety a CBD rich strain is recommended and then below as you can see it also states to avoid high CBD as this in itself may cause anxiety. I'm perplexed and wondering if you could point out what I'm missing please. You do actually reiterate that a high CBD strain is preferable lower down in your dosing summary which has me further wondering:

"* For anti-anxiety or anti-psychotic choose strains or meds high in CBD or an indica hybrid."

Thanks for any response in advance and I hope that you are well, once again thanks for providing me an interesting read, one of many I have enjoyed since joining the magazine. May your buds be forever bountiful

I can see the confusion Kraize. This thread was from class note of a course I took on Green Flower Media, and I can see it could use a little editing, or better yet a new companion thread with what we’ve learned since.

Ok, the high doses that’ll cause anxiety are CBD doses in the hundreds of milligrams, so that’s not likely to happen in homemade meds, unless you have a CBD isolate you can use to beef up the numbers. The only reason we’ve played with CBD that high in concentration is when you’re going through opioid withdrawal.

The major confusion, and one I only figured out myself recently, is that medical professionals refer to any chemovar with at least a balanced ratio of THC:CBD to be high CBD.

With anxiety it’s smart to try a 1:2 ratio and increase the CBD to a 1:5 before you start micro dosing in THC. The real trick is to keep the THC you’re adding in balance with the same amount of CBD. In this way you always keep the higher value of CBD as THC levels climb. It controls euphoria and allows you to get more THC in without running the ECS too hot.

With extreme anxiety you’re looking for ratios of up to 1:8 THC:CBD.

Someone dealing with depression will spiral into it with indica-based drugs. The same is true for anxiety patients on sativas. You have to be alert for suicidal thoughts. It’s the terpenes that’re creating the chaos in each case. Pinene and limonene, in particular, stress an anxious system in the same way linalool and myrcene will a depressed countenance.

Did I make that any clearer?

 

[Kriaze]

Thanks for trying to explain, although this soon out of bed I could probably have settled for the first part of the answer without the extra information regarding the limonene and pinene because as far as I was aware pinene~a is in all strains of Cannabis. I remember posting this in the thread regarding the effect of pepper vs paranoia or some such thread that I found interesting. Maybe I should go revisit the thread or reread the paper from the British Journal of Pharmacology, it's been so long and so many highs since lol.

Anyway that's me off on a quest to refresh my memory, all the best on your quest for knowledge

 

[SweetSue]

Yes, a-pinene is found across the spectrum of cannabis lines, but it’ll show up in various concentrations.

Have fun relearning. Please share what you learn.

 

[Hazeri]

I came to 8 pages.Sue,rethe queen

 

[SweetSue]

I came to 8 pages.Sue,rethe queen

Awww... I love what I do Hazeri.

 

[Hazeri]

If any meds contain the caution to avoid grapefruit juice, this is a red flag for your CBD cannabinoid therapy. Isolate CBD products will probably interfere with the timely degradation of these medications, causing them to build up in the system, with the danger of toxicity. Speak to the physician overseèing those medications, even if you're using a whole plant extraction. The CBD isn't the problem here. The overload of the pharmaceutical is.

Sue, did you imagine how to consume cbd that medicines do a lot less to do toxicity for HCV men? It is consumed 1 hour before taking the medicine. Is that right?

 

[SweetSue]

Sue, did you imagine how to consume cbd that medicines do a lot less to do toxicity for HCV men? It is consumed 1 hour before taking the medicine. Is that right?

This caution applies mostly to CBD isolates. A full-plant extraction will have a wealth of other components that work in synergy to keep things more even. It’s still a good idea to have the medical team watch lab results more closely.

If it’s going to be a concern for someone it’d be best to make that hour separation for dosing, but it’s more important that the lab results be watched to see if anything’s building up. The CBD molecules get first preference in being transported into the cells, effectively blocking the pharma drugs trying to take the same pathway.

The solution is not to limit CBD, but to adjust the pharma drugs to match their bioavailability.

 

[Hazeri]

but it’s more important that the lab results be watched to see if anything’s building up.

Labaratory results are great. The bright picture is clear, the urine is clear. I think it's a great help to take the dose 1-2 hours after taking cbd Bibombs. Thanks Sue

 

[Carmen Ray]

Thanks Pigeons. I've missed you. This project, on top of doing the Sensitization Protocol, kept me completely tied up for over a week. I can't wait to get high. Let me get to bed already. I've fixed the bad links and I'm so tired right now I could cry.

Goodnight my friend.

Sue, thank you for this profoundly important and helpful curation of knowledge for public benefit. I am so grateful for your efforts. It is hard work doing this research and then presenting it in such a user friendly way for the community!

 

[Carmen Ray]

More delivery systems

INGESTION

Eating cannabis usually leaves you with a stronger, more deeply felt effect that will last for hours. It takes more plant material or concentrates to get the effect than smoking does though, up to three times the quantity. This sounds crazy given the cost of cannabis, but remember it lasts 2-3 times longer in the system, so that's really not as bad as it seems at first.

* Onset can be delayed up to an hour or two, if you do nothing to enhance the bioavailability. We have a plan for that on site that we're pulling together at the moment. It'll be posted on this thread as soon as possible.

* The effects will peak and be available for 1-6 hours, dependent on the severity of what you're treating and the strength of the patient's digestive system.

* The liver converts THC into 11-hydroxy-THC. This metabolite is in smaller concentrations when you smoke, because the cannabinoids go straight to the brain, bypassing the liver that first time. 11-hydroxy-THC is a potent psychoactive metabolite, but it's also effective as a sedative. It does, however, lack the same medicinal benefits that THC offers.

If you use techniques of competitive inhibition you can increase the number of THC molecules that make it through the liver unmolested and still medically beneficial. Here's a link to some good ideas on doing that.

Competitive Inhibition

* Bioavailability is pegged at 6-20%.

At 6-20% bioavailability 1 gram of cannabis will supply 20 mg of cannabinoids, only 1-4 mg of which will be THC.

* Edible preparations are a great option if you're dealing with a chronic condition, where you want high doses that will carry you through a 24-hour period.

* The cannabinoids that make it through the stomach and the liver are absorbed through the intestinal tract into the bloodstream.

* The canna foods you're using have to be digested too, so a big part of the effectiveness of this delivery method hinges on the health of the patient's digestive system.

DOSING CANNA FOODS

* Always precede your canna dose with a small oily meal. Something as small as a tablespoon of coconut oil will keep your liver occupied as the cannabinoids are squeaking through, allowing more medicinally valuable cannabinoids to get through without being metabolized.

* The effects begin somewhere within 2 hours of ingesting.

* It's easy to overdose on edibles, and once in, you can't get them out. They have to work through the system. Start small and increase slowly. Wait 12 hours between the initial doses and evaluate carefully. Utilize the Internal Inventory.

The Inner Inventory.

This is a self-awareness technique used by Dr. Dustin Saluk to teach his patients to increase awareness of their body in the early stages of dosing. It's a helpful tool at any time.

Before and five minutes after the dose sit and ask yourself these three questions.
1) Take a deep breath. How easy was that to do? Rate it on a scale of 1-10, 1 being "Ouch!" and 10 being "Ahhhhh....."

2) How comfortable is it for you to sit still? Again 1-10 with 1 being "difficult, if not impossible" and 10 being "no trouble at all."

3) How are you feeling mentally and emotionally? Rate as 1 being "Stressed to the max!" and 10 being "Peaceful and calm."

Write this down every time you dose during the early stages of setting the dose. After you find your optimal therapeutic dose, test it out for 2-3 dosing sessions. After that you don't have to wait five minutes between administrations.

* Use depends on the potency of the substance prepared, for example, 1/4 of a cookie, 1 tablespoon of butter, one capsule, etc. As such, doses for capsules can range from 0.1-0.5 gram/capsule, and ten times higher (10-50 gm/capsule) if those capsules have CCO in them.

* A typical capsule dose would be 3 x/day for 24 hour coverage.

* If the digestive system is compromised the effectiveness of the dose can suffer up to a factor of 10.

HIGH DOSE OPTIONS

This is for edible or rectal doses.

Capsules with CCO can be made to typically carry 25-100 mg of cannabinoids in each.

CCO is a thick and sticky concoction that's stored in syringes, and may hold up to 800 mg of cannabinoids/ml of oil. We have numerous places on site that can assist you in producing your own. I maintain a study hall dedicated to this very subject. Feel free to stop in and ask questions.

Cannabis concentrates with coconut oil can be cut with a knife into grains.

Some cancer patients use over a gram of CCO /day.

Advantages
* No smoke to deal with.
* This delivery system is long-lasting, bringing up to 8 hours of effect. It's one of the few delivery systems that'll get you through the night.
* It's food as medicine. It doesn't get any more basic than that.
* Prepared foods can easily be stored in frozen form for months.
* You can dose as with other oral meds, 3x/day.

Disadvantages
* Edibles have that slow onset, unless you bio bomb it. (See link above)
* It may be too long-acting for some. You can't turn it off.
* Preparing edibles takes more resources.
* It may cause stomach irritation, so be alert for that possibility.
* Precise dosing is challenging, given the wide variability of the foods and the strength and health of the patient's digestive system.


SUBLINGUAL (OROMUCOSAL) DELIVERY

Cannabis can be delivered through the mucosal lining of the digestive tract by using a tincture. Tincture are extracts of cannabis into an organic solvent, such as alcohol or glycerin. They're absorbed directly into the bloodstream in the mouth (under the tongue is an effective location) and as you swallow.

* It doesn't have to be digested.

* There are a number of products that will have submucosal absorption, including lozenges, lollipops, mouth strips, gum, mouth spray and tablets.

* Mucosal absorption has a more rapid onset of action, less than 30 minutes, but can last as long as 4-6 hours.

TINCTURE VS OIL

* Both products can be delivered by sublingual (oromucosal) absorption.

* Tincture is absorbed rapidly, while oil gets stored in fat cells and released over a longer span of time.

* Alcohol is an efficient extraction method, pulling out chlorophyll and all the cannabinoids and terpenes.

* Glycerin is less efficient than alcohol, with a lower yield. It doesn't retain chlorophyll, but does pick up the cannabinoids and terpenes.

* You can increase the potency of your glycerin tincture by doing a second round with fresh material. Strain and press out the original plant material and replace it with fresh. Follow your process once again, typically another 1-2 months.

* Oil extraction is very efficient in yield, retaining all of the cannabinoids. However, the process leaves the chlorophyll behind and the heat typically used in the process destroys the terpenes and flavonoids.

* Cannabis fluid extracts come in bottles with droppers for dosing.
Average concentrations of prepared tinctures:
- alcohol: 10-15 mg cannabinoids/ml
- glycerin: 3-10 mg cannabinoids/ml
- oil: 1-2 mg cannabinoids/ml. (Can be more with better extraction practices and a potent strain.)

SUBLINGUAL DOSING

* A moderate dose is required.

* There'll be a moderate onset in 15-30 minutes.

* Absorbed in the mouth, the dose is good for 2 hours. Swallowing, the dose will carry for 3-5 hours. Much depends on the potency of the meds.

* Mouthstrip dosing is every 2-4 hours. Canna strips contain 20 mg cannabinoids/strip.

* Start Low and Go Slow
- Begin with a few drops and gradually increase to several droppersful per dose.

* One dropper is approximately 1 ml.

* A typical tincture dosage is 3-4 x/day for 24 hour coverage.

* You're looking for 5-20 mg cannabinoids/dose.


Advantages
* There's a rapid onset, within 15 minutes.
* Products are easy to transport.
* There's no cannabis odor. This is a stealthy delivery method.
* It's easy to get a measured dose, and it's easy to repeat that measured dose. Consistency of dosing makes this delivery method a preferred one by many physicians.
* Most products have a long shelf life.
* The doses are moderately long-lasting at 5-6 hours.

Disadvantages
* Unless you make your own you can't choose the strain being used.
* Good products may be difficult to procure commercially, especially the invaluable mouth spray.
* There's a widely variable range of potency.
* Products can be more difficult to make at home.
* Most products don't taste very good.


RECTAL DELIVERY

There's no denying the fact that rectal delivery works. There's still a lot of controversy in the medical community concerning this, but we have members who can testify that the delivery method works, in that they're still alive and actively eliminating cancer from their own bodies. So the medical community can debate this point all they want. Until a believable study comes along to convince us that we're all spitting into the wind, we stand behind our belief that suppositories infused with CCO will indeed help your body guide itself back to homeostasis.

* Most of the meds will be absorbed directly into the bloodstream. This means no first-pass through the liver, a very desirable effect. If you incorporate competitive inhibition into the regimen, you can do better than average on the second time through the liver too. Worth looking into.

* Suppositories are effective vaginally too.

* Suppositories are made with cannabis infused cocoa butter. Delivery can also be done with a syringe using coconut oil.

* This method has been a good choice for delivery into the pelvic and lower abdominal areas. According to cajuncelt this has also been shown to benefit patients treating breast cancers, and I know other members have spoken of patients they've known who used suppositories to successfully treat lung cancer.

* The FORIA vaginal suppositories are 240 mg THC + 40 mg CBD. A good example of the potential.

RECTAL DOSING

This is an area of treatment in its infancy, so we're still learning as data accumulates. In the medical community it's a limited patient pool. This will change as the wave to legalize sweeps the country.

* Suppositories are typically made with cocoa butter or coconut oil. These carriers will help speed absorption.

* Effects can begin within 15 minutes and last 6-8 hours.

* Similar doses to those administered orally can be achieved, from a low of 10 mg to as high as 200 mg/dose.

* This route is suitable for those in need of high dose therapies but cannot or do not want to take the oral route, for example someone who can't swallow or someone who doesn't want to get the psychoactive effects.


Advantages
* You can target the local pelvic and lower GI areas.
* There's increased bioavailability, compared with oral dosing.
* It may be more cost effective for higher doses.
* You can achieve higher doses with less psychoactivity.
* The dose is moderately long-lasting.

Disadvantages
* The method is relatively new to the medical field, so supporting data is difficult to find at this time.

* There's little information available about dosing, because at this stage, most of it's being done at home, in private, in states and countries that enforce prohibition and tie the hands of the professional caregivers.

* Unless you make your own, strain-specific products are not available.

* This is not a popular choice for most patients. Most aren't familiar with the method and even more are uncomfortable with the idea.

Let me share with you the perspective of an actual patient who overcame this discomfort, speaking to another patient reluctant to try suppositories.



Rectal delivery works. Enough said.

Hi again sue. I hope you are well. I am interested in finding a recipe for a nasal spray. Have you guys discussed that in this forum?

 

[SweetSue]

Hi again sue. I hope you are well. I am interested in finding a recipe for a nasal spray. Have you guys discussed that in this forum?

Sorry to miss this for so long MG. As far as I know no ones raised it before you. If you’re still interested let me know by PM and I’ll see what kind of interest we can stir up. It’s an amazingly talented membership.

 

[medmanmike]

I’m interested!

 

[OlJoe]

Cannabis Tolerance: More is not always better.

Most people only know to increase the dose when cannabis begins to work less effectively. Unfortunately, this can work against you, since an overload of cannabinoids will cause a decrease in receptors. It's part of the way your body evolved to protect you from overstimulation. Most chronic users are working with an overstimulated system and have developed a tolerance to the meds, leading to the need to consume more and more cannabis to get the same effect.

If you use concentrates or strains with extremely high cannabinoid counts your system will build tolerance faster.

CBD-dominant strains produce a different type of tolerance than THC-dominant strains. If you can toggle between strains high in each of these cannabinoids you can potentially limit the development of tolerance. You heard me say "potentially" right? This is still new learning, so we're still lab rats, to some extent.

The Herbal Holiday

It's an age-old policy when working with herbal therapies to regularly challenge the treatment, to see if you need the dose you've been using. This should be part of your own protocol. If cannabis is working for you, take a brief holiday to see if it's possible your Endocannabinoid system has begun to pick up the slack and you don't need as many supplemental cannabinoids.

Some recommended schedules for the Herbal Holiday:

* 1 - 3 weeks out of every 3 - 4 months
* 5 - 7 days a month
* 1 day a week
** If stopping meds isn't an advisable option, change strains. In particular, try to change up the levels of CBD and THC.

The Herbal Holiday resets your tolerance level, requiring less cannabis to get the desired therapeutic effects.

On a personal note, I'm finishing up my own herbal holiday, following Dr. Sulak's 6 Day Sensitization Protocol, and I can tell you this isn't an easy thing to do if you're a chronic user at the levels most of the successful harvesters on this site reach. We're kind of a special group, with more access to better quality cannabis than the average Joe. At noon today I finally break my protocol and find my new tolerance level.

I won't be repeating this again, if I can help it. I'll choose the occasional break for a day or two. I do recommend you test your own system, at least once.

I hear you on the tolerance break. Nowadays I tend to do my TB with CBD herb only for a couple days. I am not at all sure my aching joints would allow a week long break. Love your post Sue, good for you!